Lessons learned, when the unimaginable happens

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Hostage siege at Duke Medical Center


The report in The New York Times was only three paragraphs long.

The headline read, “Gunman holding hostages is fatally shot at Duke U.” The report detailed how Ricky Lamont Coffin, a 23-year-old man who was awaiting trial on burglary charges, escaped from jail in High Point, NC, and took four people hostage at gunpoint at Duke University on October 27, 1992. Coffin held the police at bay for two hours before a sharpshooter fatally wounded him.

Coffin fired several shots in the direction of the police, bystanders, and a television camera from a fourth-floor window of Baker House, part of the Duke Medical Center complex.

None of the hostages were hurt in the standoff, which ended when a police marksman fired from a parking deck more than 15 yards away and hit Coffin in the face. He died in an operating room at Duke Medical Center.

That may sum up the story, but for Clarence F. Birkhead, former chief of the Duke University Public Safety Department in Durham, NC, there is more to tell. Which is why Birkhead, who worked at Duke for 18 years before becoming chief of police at the Hillsborough (NC) Police Department in 2005, shares the story of how the unimaginable happened that day.

Keep in mind that this was 1992—years before the names Columbine (1999) and Virginia Tech (2007) were seared into the national consciousness. That day’s hostage drama was indeed far more unimaginable than today, when news of horrific shootings seems to be constantly in the headlines.

Off the radar

Although the Duke University Public Safety Department—which included about 60 sworn police officers and 65 security officers who served the university and medical center—had procedures in place to respond to incidents such as an infant abduction or a disruptive patient in the ED, officers had never trained for the possibility of a hostage situation or an active shooter on its campus, Birkhead says.

“It just wasn’t the topic back then. Now it’s all changing,” he says.

Many hospital police and security departments now train their officers on how to handle these violent situations and have learned from cases such as the hostage taking at Duke.

“We have to prepare ourselves. I say to people, ‘You may not think it can happen to you and your facility.’ But if it can happen in a hospital, a community center, a nursing home, such as we’ve seen in recent events, it can happen to you,” Birkhead says.

That point was driven home by a March 29 shooting in Carthage, NC, not far from Birkhead’s town. A gunman walked into a nursing home and fatally shot seven residents and a nurse before the rampage ended when a local police officer wounded him.

“If it can happen in Carthage—which is as nice and quiet a town as you can imagine, where everybody knows everybody, and you have eight people who died—it can happen everywhere,” Birkhead says.

What happened at Duke

The shooting at Duke took place on a Tuesday that began like any other sunny fall day in North Carolina, Birkhead says.

The university’s public service department had its first hint of trouble when officers heard about a chase involving Coffin, who had escaped from the Guilford County Jail. Officers were familiar with Coffin, who had lived in Durham and had some encounters with the department as a juvenile.

Coffin knew the Duke campus and had family members who worked at Duke Medical Center. It wasn’t long before Coffin, who had hijacked a car, was spotted on the Duke campus, Birkhead says. Coffin was on foot after crashing the car and was armed with a 9mm handgun, a weapon he took from a locked gun box at the jail after stealing a key.

“It seemed to never run out of ammunition,” says Birkhead. Coffin’s familiarity with the campus allowed him to elude Duke officers in a pursuit that lasted several hours and included exchanges of gunfire, he says.

Coffin made his way to the medical center, weaving his way through the campus, and ended up at Baker House, which housed several clinics and medical offices. It was midday and the building was full of activity, including people working in the offices and patients there for appointments. Coffin took four workers hostage, at one point using one of them as a human shield, and locked himself inside a suite of three or four offices. He eventually released two of the employees, using them as messengers to communicate with law enforcement outside the building. Two other people hid in a closet throughout the ordeal, with Coffin unaware of their presence.

Police surrounded Baker House and began negotiations, but Coffin left law enforcement with few options, Birkhead says. He shot out the window three or four times and broke off communication with police. A sharpshooter, who was a member of the Durham Police Department’s SWAT team, ended the hostage siege with a shot that struck Coffin in the head.

“It was very chaotic, very emotional, and very tension-filled,” Birkhead says about the incident, which lasted about eight or nine hours.

Coffin had previously served time in jail, and if he was found guilty of the burglary charges against him, he would likely have faced more prison time. The demands he made to law enforcement—that he be given a car and a clear escape route—were not going to be met, Birkhead says. “I think he was very frustrated and agitated. He made demands we couldn’t give him,” he says.

Lessons to take away

So what lessons can other hospitals learn from the hostage-taking and shooting at Duke? “No one did anything wrong,” says Birkhead, but with a Monday morning quarterback–perspective and knowing what law enforcement knows now, there are things that would have been done different today.

The following are some of Birkhead’s recommend-ations for dealing with a similar situation:

Set up an incident command center early on. At Duke, law enforcement did not activate an incident command center until Coffin was holed up inside Baker House. An incident command center establishes a clear chain of command for everyone involved, Birkhead says. In retrospect, officers should have taken the time to activate a command center while the hunt for Coffin was taking place.

The drama unfolded rapidly and kept evolving, says Birkhead. Coffin would be spotted in one place on campus and would then evade capture. At one point, he stole another car. Officers kept moving the perimeter of their search area, as Coffin continued surfacing in different areas. In retrospect, if they had left the perimeter in place, they might have caught him, Birkhead says.

Systems such as the National Incident Management System train law enforcement to have a clear command structure. “Everyone knows who is in charge,” he says.

Be prepared to work with multiple outside agencies in an emergency situation. One complication during the hostage situation was that there were multiple law enforcement agencies involved, says Birkhead. There were officers on the scene from the Duke University Public Service Department, the local Durham Police Department, the North Carolina Highway Patrol, and the Guilford County Sheriff’s Office.

A captain from the Durham Police Department took command once the command center was activated. In an emergency situation, you want a person designated as the leader. “What you don’t want is two or three people debating what to do next,” Birkhead says.

Teach your police and security officers how to react to these violent incidents. Times have changed, and with shootings in the news, Birkhead says hospitals, especially larger medical centers, are training their security or police forces to handle these kinds of incidents. “I think hospitals are taking a different look at how they train their security force,” he says. “Prior to this incident, we had not drilled specifically for this.”

Have clear policies in place that allow police to respond quickly. But can law enforcement really ever prepare for these kinds of events?

Yes, Birkhead says. “Can you prevent it 100%? No. If an individual decides they are going to do something, most of the time, there is little we can do to stop them,” he says. “But we have to be ready to act quickly. We are risk managers.”

Look at ways to minimize risks, such as using metal detectors to help keep guns and other weapons out of hospitals and training staff members to recognize suspicious behavior and alert security or police.

Training can mean that law enforcement is ready to foil an attempt by a gunman to take lives, Birkhead says. In the Carthage nursing home shooting, a police officer was first on the scene, went into the facility, and wounded the gunman, ending the killing spree. “He did exactly what he was supposed to do. There is no doubt in my mind that he saved the lives of many people,” Birkhead says. “We can prepare for incidents like this.”

Train all staff members on what to do when faced with an armed shooter or a hostage-taking. That training should include everyone from administration to nurses and physicians to housekeeping, says Birkhead. Staff members need to think about how they would react in such a situation. Would they know to get to a phone to let hospital security know what is happening? Or to grab a cell phone and call law enforcement and say, “Here’s what’s going on inside the building”?

Staff members should know your procedures for evacuation of the hospital and for a lockdown. You also have to get information out to staff members.

One criticism after the Virginia Tech shootings was that officials didn’t get the word out quickly enough to alert people on the campus to danger. Have procedures in place to call, e-mail, or put up flyers alerting people to what is happening, Birkhead says.

Partner with law enforcement agencies in your local jurisdiction. Just as safety officers work with local fire departments so firefighters know the layout of a hospital, hospital security directors should make sure local law enforcement knows the layout of the facility, both inside and on the grounds.

Consider the buildings and other facilities you have outside the main hospital. Practice drills in those facilities as well, says Birkhead. At Duke, security officers and nurses were prepared to respond if violence spilled over into the hospital ED.

“We knew how to lock down the ER if a certain trauma case came in,” he says. “We had not practiced in our clinic building. I think now, especially your larger facilities have thought about that and expanded their protocols.”

Be prepared to deal with the media. Keep people, including members of the media, away from the scene. Set up an area for the media with a clearly established perimeter. “People were just everywhere,” Birkhead says about the scene outside Baker House.

Officers should have set a perimeter farther out and also set up a room for the media.

The media can be helpful in conveying information, but you need to control their presence at the scene, says Birkhead.

Be prepared to handle family members. In the hostage drama, Coffin’s family members who worked at the medical center also came to the scene. Looking back, they should have been taken to a room inside the facility and away from the scene, Birkhead says.

Hospitals must be prepared for the arrival of family members looking for news about their loved ones.